Wednesday, September 16, 2009

What If?

What if the Obama healthcare reform is enacted? The doctors ponder. The hard-pressed families wonder. The unemployed folks brood over.

Since December 2007 when recession was declared, more than 15 million people have lost their jobs. Many since then have changed careers, many taken huge pay cuts out of necessity. Many live in fear because they can no longer afford the costs of healthcare for their families.

Jobless, hopeless.

Men who used to be breadwinners have lost three out of every four jobs cut anywhere. Women have become breadwinners while men are unemployed.

Now when you apply for a job, you face tremendous odds. Only few openings and a horde of applicants many of whom are more qualified than you. You used to make $100K a year. Now you make $50K and feel thankful for having a job just to make ends meet and, most important, restore your self-esteem.

If you don’t have a job, you’re joining 17 million people who are either unemployed like you, or have no healthcare coverage through their jobs, or are early retirees.

So everyone asks “What if?” What if the proposed reform becomes a done deal?

The reform will reportedly provide subsidy for those who cannot afford hospitalization; however, they still must buy insurance coverage. For those who buy their own insurance, in spite of the promised subsidy that will have them pay a premium of no higher than 9 percent of their income, they still must pay co-payments, deductibles. Swell. What about those who have had a history of preexisting medical conditions? These people face higher premiums and full deductibles. Insurers sometimes reject them. Can the reform protect them? Can the government restrain the insurers from jacking up prices? If not, many of us better hope that we would live till 65 and embrace Medicare. Or work till we drop dead.

Well, doctors don’t like the proposed healthcare reform partly because they will be banned from owning stock in healthcare companies. Also, the reform will aim to stop the doctors’ overtreatment of patients, which accounts for 20 to 30 cents of every healthcare dollar.

Yet, despite several provisions deemed good in the proposed healthcare reform, many of us keep asking ‘What if?’ What if any of the following provisions become true (source: www.FreeRepublic.com)?

A government committee will decide what treatments and benefits you get (and, unlike an insurer, there will be no appeals process).

The “Health Choices Commissioner” will decide health benefits for you. You will have no choice.

All non-US citizens, illegal or not, will be provided with free healthcare services.

The federal government will have direct, real-time access to all individual bank accounts for electronic funds transfer.

Taxpayers will subsidize all union retiree and community organizer health plans (example: SEIU, UAW and ACORN).

No company can sue the government for price-fixing. No “judicial review” is permitted against the government monopoly. Put simply, private insurers will be crushed.

The American Medical Association sold doctors out: the government will set wages.

Another ‘What if’: Will the reform support the thrifty walk-in medical clinics? These are run by CVS, Wal-Mart, usually within a 10-minute drive from where you live. You don’t need appointments; you can walk in on weekends or evenings, and waiting time is short. You pay 30 to 40 percent lower in fees than at the doctors’ offices and 80 percent lower than at the emergency departments. So if the reform is to deliver improving value in healthcare, will these walk-in clinics fit the bill?

When is the healthcare reform to be voted on? In about a month.

Surely it will be the most ambitious healthcare reform in this century, if passed. Yet who has a handle on it? Not the doctors. Not us, the American citizens. Only the lobbyists, the special interest groups. Is it a disquieting fact to know that the most recent Gallup Poll showed that more, many more Americans still trust their doctors more than they trust the politicians?

All summer long, constituents have screamed and shouted at their congressmen, “Do you know why we aren’t on board?” Why? Because this impending reform will tamper with the holiest thing of our lives: our personal health. When it boils down to this, do you trust your politicians?

So, if we the Americans are kept in the dark in this healthcare reform crusade, we will keep asking ‘What if?’

4 comments:

I've written a lot about healthcare contracting on my blog. By far the biggest winners in terms of financials are the healthcare industry CEO's and other executives. Having over 20 years of experience, believe me --I've seen every reincarnation of medical group, morphs from private to groups, and now ...quite honestly, the death of the solo practitioner.

The main worry is that while doctors will accept lower and lower fees (On average, if we billed an insurance company $100 for a visit, we'd get anywhere from $15 to $45 --often not even covering the staff time it took for authorizations), the healthcare insurance industry is NOT going to give up their share of the pie.

In other words, Medicare, Medicaid, Tricare are all presently contracted to private healthcare insurers (Aetna, United, Blue X) to provide the care guaranteed. From here, it's contracted out again, and subcontracted ad infinitum. The lions share goes to the industry insider themselves, and very little goes to the doctors to run their practices which run under a free market economy. In other words, while the payments to them are capitated, their business expenses are not.

Go over to my blog, type in healthcare and there are at least 5 articles.

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Khanh Ha studied Journalism at Ohio University and learned the craft of writing under Daniel Keyes (Flowers for Algernon). He is the author of Flesh (2012, Black Heron Press) and The Demon Who Peddled Longing (2014, Underground Voices). He is a seven-time Pushcart nominee, a Best Indie Lit New England nominee, a twice finalist of THE WILLIAM FAULKNER-WISDOM CREATIVE WRITING AWARD, and the recipient of Greensboro Review’s 2014 ROBERT WATSON LITERARY PRIZE IN FICTION. The Demon Who Peddled Longing was honored by Shelf Unbound as a NOTABLE INDIE BOOK.

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Then there was the bad weather. It would come in one day when the fall was over. You would have to shut the windows in the night against the rain and the cold wind would strip the leaves from the trees in the Place Contrescarpe. The leaves lay sodden in the rain and the wind drove the rain against the big green autobus at the terminal and the Café des Amateurs was crowded and the windows misted over from the heat and the smoke inside. It was a sad, evilly run café where the drunkards of the quarter crowded together and I kept away from it because of the smell of dirty bodies and the sour smell of drunkenness. The men and women who frequented the Amateurs stayed drunk all of the time or all of the time they could afford it; mostly on wine which they bought by the half-liter or liter. Many strangely named apéritifs were advertised, but few people could afford them except as a foundation to build their wine drunks on. The women drunkards were called poivrottes which meant female rummies.

The Café des Amateurs was the cesspool of the rue Mouffetard, that wonderful narrow crowded market street which led into the Place Contrescarpe. The squat toilets of the old apartment houses, one by the side of the stairs on each floor with two cleated cement shoe-shaped elevations on each side of the aperture so a locataire would not slip, emptied into cesspools which were emptied by pumping into horse-drawn tank wagons at night. In the summer time, with all windows open, you would hear the pumping and the odor was very strong. The tank wagons were painted brown and saffron color and in the moonlight when they worked the rue Cardinal Lemoine their wheeled, horse-drawn cylinders looked like Braque paintings. No one emptied the Café des Amateurs though, and its yellowed poster stating the terms and penalties of the law against public drunkenness was as flyblown and disregarded as its clients were constant and ill-smelling.

All of the sadness of the city came suddenly with the first cold rains of winter, and there were no more tops to the high white houses as you walked but only the wet blackness of the street and the closed doors of the small shops, the herb sellers, the stationery and the newspaper shops, the midwife—second class—and the hotel where Verlaine had died where you had a room on the top floor where you worked.

—ErnestHemingway(A Good Café on the Place St.-Michel)

19 inches of a green screen tv

The tv was on. Kids stared straight into the tube, heads held by miniature hands.

It was a black & white set, with a piece of green plastic glued to the tube. The old man liked it like that. It stayed like that. Period.

Kennedy was killed on that tv.

Vietnam was started on it.

It was a damned television.

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